Provider Demographics
NPI:1174854293
Name:BRADY, JEREMY DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:DANIEL
Last Name:BRADY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W CRESTWAY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-1850
Mailing Address - Country:US
Mailing Address - Phone:316-788-3800
Mailing Address - Fax:316-788-3808
Practice Address - Street 1:205 W CRESTWAY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-1850
Practice Address - Country:US
Practice Address - Phone:316-788-3800
Practice Address - Fax:316-788-3808
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor